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City of Fridley, Minn. N° 8782
•
MUDING PERMIT
Date: April 19, 1966
n
U
Owner: Ardis McCarty Builder Ardis McCarty
Address Address 3654 Van Buren St. N'_ E.
LOCATION OF BUILDING
No. 17 Street - 67th Way N .E . _ Part of Lot
Lot mo -- Block 2 Addition or Sub -Division . Erlga=ter 6av- ass
Corner Lot . _ Inside Lot x Setback 35' Sideyard 10'-251
Sewer Elevation T _ 836.64 83$.64
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as: //.�, ,?3.0-6
Dwelling Front _28' _ Depth 421 Height 20' Sq. F't. — Cu. Ft. 21757
Garage Front 22 Depth 22' Height _ 1 Of Sq. F't. G.Rb Cu. Ft. --4,8"
Type of Construction Frame Est. Cost $1h,.(?Q0__ __ To be Completed -1
SEWER -- "Y" is located 39' East of manhole
WATER -• 10' West of sewer
In consideration of the issuances to me of a permit to construct the building described above I agree to do
the proposed work In accordance with the description above set foy h and in bea} Dance ash 21 provisions of
ordinances of the city of Fridley. // 17 %S
In consideration of the payment of a fee of permit is hereby granted rills McCarty
to construct the building or addition as described above. This permit is granted upon
the express conditionkbultl9d
peon to whom it is granted and his agents, employees and workmen, in all work
earound and d dley, >,Riaaesota rper�acity limits flans upon vlolatton of aqy of the provisions of esaaiid
NOTICE
M pomdt doe not Cera the cendmCBoe, hwhWee for wWno, ph mhleo, Ba hodhgb ewer or water. Bo sun to see
do Bundled faspaaler for soparafe pamifs for ties ft"M
WA . .
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME + BUILDER
ADDRESS ADDRESS -�
LOCATION OF BUILDING
NO, 12
STREET
L4DT I.Zp BLOCK ADDITION OR SUBD'
CORNER LOT INSIDE LOT! _SETBACK J
OF LOT
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as;
FrontDepth 4,/' -2�eight
Sq. Ft. Cu. Ft.
' Front Depth-ight
Sq. Ft. Cu. Ft._�
Type of Construction_ - Estimated Cost zzG a -
To be completed_ �_ J „9
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true -and correct.
DATE
(Schedule of Fee Costs can be rouna on tae Reverse siae).
City of Fridley
SUBJECT
0.
16709
AT THE TOP OF THE TWINS
BUILDING PERMIT
i �
•COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
v7
I
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/4/82
JOB ADDRESS 17 - 67th. Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
2
1 Edgewater Gardens SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert Graham 17 - 67th Way N.E. 574-7416
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Sundown Construction Inc. 4509 Heights. Drive N.E. 571-8979
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 1313" x 919" Family di '
9 CHANGE OF USE FROM TO
STIPULATIONS
g8FpMTE PERMITS RIQUIRED FOR 14
la o
HEATING, PLUMBING f1�VD StG iSa 1 ut 0kes
na ta111ac�� G Etc.
N` �ti tic -
sems
NE.ilia
�E
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
129
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$4,700
$2.35
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
NONE
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$50.50
PLAN CHECK FEE
TOTAL FEE
$12.63
$65.48
SIGNATURE OF CONTRACOR AUTHORIZED AGENT coarEl
VWHEN PROPERLY VALIDATED THIS IS Y
—ori7lil
BLDG WSP DATE
"-SIGNATURE OF OWN IIF OWNER BUILDERI (DATE)
of V
CITY OF- FRIDLEY Effective Aug. 1, 1981
APPLICATION FOR RESIDENTIAL BUILDING PEW4iTS
(Nw, Alterations, Additions, or Repairs)
OWNER:
ADDRESS:
l
TEL N0:
• STREET NO:
LOT:
STREET:
BLOCZC :
BUI LDER :
ADDRESS:
TEL 140:
Construction Location
Corner. Lot: Inside Lots � Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOIN OF CONSTRUCTION
�� ► ��f Front: 13 JJ Depth: Height:
Square. Feet: Wk Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
. � /241 w3c.ze- : t/V1uy N710d
Type of Construction: Estimated Cost: $IV,
'!b Be Completed: �ejf%!
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the Mork' herein specified,
agreeing to cb ,all work in strict accordance :with the City of Fridley Ordinances and
rulings of the Delhlrtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
UWE: f (� v 9 �2L SIGNATURE:
Stipulatio
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CITY OF FRIDLEY INSPECTION DIV,
Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3664 REFRIGERATION AND
AIR CONDITIONING
SYSTEMS AND DEVICES
J013 ADDRESS � -7 /�,�, („ � (�4.� A).
Ac�
The undersigned hereby makes application for a .permit for the work herein
Residential Rate
TOTAL
speoifed agreeing to do all work in strict accordance with thb City Costes and
Fumace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Fumaoe $ 24.00
$ d
representations stated in this application are true and correct.
Gas Piping (Needed with new furnace) S10.00
OWNER
Gas Range $ 10.00
$
BUILDING USED AS
Gas Dryer $ t0.00
$
—
ESTIMATED /-
ESTIMATED COST S' ads PERiv9T NO. /;/ee
*Air Conditioning - All Sizes $ 40.00
$_1
'
All Others/Repairs &Alterations (LIST ON BACK)
DESCRIPTION OF FU1RN6CND OR SUREIER
1% of Value of Appliance or Work
$
No. of Heating Units I° Circle One (Steam) (Hot Water) Earm:Ajir
Commercial/Industrial-
Trade Name L e-OtA. K Size No. %4 7
BTU 7S po HP Yjr EDR
1% of Value of Appliance or Work
$
ruel ,4 Total Connected Load //0 IP
State Surcharge
.5
Burner Tracie Name Size No.
TOTAL FEE
, ��
BTU _ HP I"DR
MINIMUM FEE FOR ANY HEATINGICOOLINGIVENTILATION
REFRFGERATIQN#1 - CONDIT10NiNG PERMIT IS X15.00
PLUS THE $.5o STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining {property owner.
P
HEATING COMPANY 4
v ®
Signed 3 g YTeJ No._�/%e/�
�j Approved By. A4 Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
l REPLACEMENT FURNACE
01
SUBJECT
P I.-
City of Fridley
3 r 017
AT THE TOP OF THE TWINS
BUILDING
PERMIT
I
RECEIPT NO.
.......COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
z1 qzl
1 �
= 1 CITY HALL FRIDLEY 55432
,'�
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/6/99
JOB ADDRESS 17 67th Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
2
lEdgewater Gardens
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Robert Graham
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Richard Hastings Contr. 6331 Riverview Ter NE Fridley
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION XG9 REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reroof house and garage 25 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2185
$1.09
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
Fire SC $2.19
PLAN CHECK FE
TOTAL F
�`� ��-- � 6 P
Licen SC 5.00
3
SIGN TORE OF CONTRACTOR ORA HoRiZED AGENT i ATE.
EN P OP
L (DATED S IC.J P T
9l go
s
BATE
S,GNATURE OF OWNER.IF OWNER BUILDER, iDATE,
01
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: / 7 6" 7 f� VJ A/
Legal Description:
Owner Name & Address: Z o t i k- T (9 k A % A m, Tel. #
Contractor: d C -A A e /JA S f; k(6 s MN LICENSE #
Address: i ` v � e y ? Tel. # y7g -V zc
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF INIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: Z 5 .�*� .
Construction Type: -F�'A Z Ft= `�� �� Q Estimated Cost: $ --,? l o S
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
9
DATE: 6 A? APPLICANT: Tel. #
TOTAL
STIPULATIONS:
$ 0� S
CITY USE ONLY
Permit Fee
$ ��� �S�
Fee Schedule on Reverse Side
Fire Surcharge
$ d_ l
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /, C)q
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ S, C)1
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$ 0� S
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
763) 572-3604 FAX: (763) 571-1287
ADDRESS 17 67TH WAY NE
PIN 153024110019
LEGAL DESC : EDGEWATER GARDENS
: LOT 6 BLOCK 2
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
PERMIT NO.: 2004-00009
DATE ISSUED: 01/05/2004
a
VALUATION : $ 6,000.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER
SECTION 310.9.1.2 OF THE 1997 UNIFORM BUILDING CODE WHEN ADDTIONS, ALTERATIONS OR REPAIRS IN EXCESS
OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS.
CAULK AND FLASH ALL EXTERIOR OPENINGS.
REPLACE 7 WINDOWS WITHIN EXISTING OPENINGS.
IS APPLICANT A CONTRACTOR? 1
APPLICANT
PELLA WINDOWS & DOORS (20165884)
15300 25 AVE N STE 1
PLYMOUTH, MN 55447
(763)745-1487
OWNER
GRAHAM ROBERT R & DIANE H
17 67TH WAY NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Bldg Insp ) Date
1 . t
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 033424
V SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
125.25
6.00
3.00
5.00
139.25
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CITY OF FRIDLEY PERMIT NO.: 2004-00009
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 01/05/2004
(763) 572-3604 FAX: (763) 571-1287
17 67TH WAY NE PERMIT APPLICANT:
153024110019
EDGEWATER GARDENS
LOT 6 BLOCK 2
BUILDING
RESIDENTIAL
CONSTRUCTION TYPE WINDOW/DOOR REPL
VALUATION: $6,000.00
REPLACE 7 WINDOWS WITHIN EXISTING OPENINGS.
PELLA WINDOWS & DOORS (20165884)
PLYMOUTH, MN 55447
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 5 PM
INSPECTION TYPE DATE INSPECTOR INSPECTION TYPE DATE INSPECTOR
SMOKE DETECTORS
FINAL
INSPECTION COMMENTS:
IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL
WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT.
THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE.
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: (D -
Legal Description:
Owner Name & Address:-*p)CAK Tel. #(p3-��_/ (p
Contractor:; PELLA WINDOWS & DOORS MN LICENSE #
Address:
1530025TH AVE N STE #100
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
PLYMOUTH, MN 55447
Attac 763-745-1400
LICENSE #20165884 ey-of the
lot, v _ -- _ -- _-- _ _ .. .: to scale.
' DES.CRA. — ON OF IMpRGVEMENT
Tel. #
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
` - e.
Estimated Cost: fir •
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: 29 �j C. 0-5 APPLICANT: Tel. #_9,59 ,59 - 3q'5-.&0
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire S=h0ge $ LQ•OCA .001 of Permit Valuation (1/10th%)
State Surcharge $ • 00 $.50/$1,000 Valuation
SAC Charge $ $1050 per SAC Unit
License Surcharge $ - 5i-00 $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 2S
0
STIPULATIONS:
/ � D
04/02/2004 FRI 13:21 FAX ELDER JONES
001/001
NEW [ ] CITY OF FRIDLEY Effective 4/1!2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 5724604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
(763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: . �, • �! •
Legal Description: %Ij
Owner Name & Address: Tel. #
Contractor. _, PELLA WINDOWS & DOORS MN LICENSE=#.
Address: 15300 - 25TH AVE. N. STE. #100
PLYMOUTH, MN 55447 Tel.
763-745-1400 a Certificate of Survey of the
LICENSE # 20165884 Aruction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length � Width Height Sq. Ft
GARAGE AREA: Length Wdth Height Sq. Ft
DECK AREA: gth Width HgtIGround Sq. Ft
OTHER:
Construction Type: Estimated Cost: $
I
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT: Tel. #��f • �7YE'
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571.1287 N using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ •�� Fee Schedule on Reverse Side
65% of Permit Fee
$ .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$$1350 per SAC Unit
$ • 2,— $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$, �. •� STIPULATIONS:
Building
a,q
1.3s
BUILDING
Permit No.:,
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd
DATE b _. i (.9 OU
E-MAIL ADDRESS
$
SITE ADDRESS 1-1
/� �YO9JR
�?+k �� Nr—
THIS APPLICANT IS:
❑ OWNERJ>93CONTRACTOR
PROPERTY OWNER/
NAME: 13® [0
TENANT
ADDRESS: m �e, CITY
—STATE—ZIP—
TATEZIPPHONE:
PHONE:115, 1 4—-7 9 1 Lo
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: LDLZEKCITY
STATE ZIP
WITH APPLICATION
PHONE AX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
NEW ❑ ADDITION
�❑
ANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �Of^ �(J=j �—
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
I. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
Xsoffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
,Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ a —7 oO OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
a,q
1.3s
$
15- circ
$
. to
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
lations
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work hick requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME DATE
Building
PLUMBING
Permit NO.•
Inspections
RESIDENTIAL APPLICATION
Received By
763-572-3604
763-502-4977
CITY OF FRIDLEY
n
YAPR
FAX
EFFECTIVE 2-19-09
DATE 4119 I p' YOUR E-MAIL ADDRESS
SITE ADDRESS I Ujtf- It
THIS APPLICANT IS: ❑ OWNER C"ONTRACTOR
PROPERTY
_4
✓{ri,�yl,Ef�
NAME:W9 L-�
OWNER/
TENANT
ADDRESS: 1"t CITY STATELW_ZIP��Z
PHONE:
CONTRACTOR
NAME: (;1+� OWWW 44 CLI,
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE, BOND AND
STATE -BOND # EXP DATE
CERTIFICATE OF
ADDRESS: B7-clD (Nj,Et,�i 4 S+- J -Il ",ACITY - STATE MIV ZIP J S Z
INSURANCE
PHONE 1 W ! - 77 5q - ZI 1 � FAX -' W 3 _'5l. 54- ?,IDS
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW_REPLACEMENT
DETAILED DESCRIPTION OF WORK MW1&#i4 R' !'eek4 m 1: bIIlG�t h ex f4 -
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
_ BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
_ _
—BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL WATER SOFTNER ($
_
_ CLOTHES WASHER _ KITCHEN SINK_ WATER CLOSET _ BACKFLOW PREV. $1
DISHWASHER _ LAUNDRY TRAY ,WATER HEATER 35 FOR IRRIGATION
_ WATER METER —OTHER
e
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p � �'� : �� x �.*, •;' 2 '•�"P x �'0.`�. �i;.. p .�'� �t `�c i, gh�� � �d,, � �,"t� r�{�� � G �+.£-�-A'1�� 1 "„� l
�+i
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y � _ �9< S".' t(�'�.y[� �, !'. t ��"yR `g §} �{ ii' �f �� `�.h �4F _ TFW �''i 3 t Y � Gni$ �� S:. •S��i SPY gyp: � 4
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,��
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�
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�' i t a� N ��r ➢ } � :. xF � ? ;ice c„ �� aF.�,
F r a ��.0 F ! e> �" �( s� xa� 2 `sa tea' �Y� t- s �-�"'-��s�• �. `���:',� z
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`z �. ! r r �'s �� 1 y / t� �� ver-, , N , �, - � 'yr a � a ' • �`�fi� �r,'��E �F;`.� ', 5 � , � t ,. � � � � .:
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT ` C'� /' PRINT NAME C4+;ee4-- DATERpm
*..
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977